Repeated introductions and intensive community transmission fueled a mumps virus outbreak in Washington State

In 2016/2017, Washington State experienced a mumps outbreak despite high childhood vaccination rates, with cases more frequently detected among school-aged children and members of the Marshallese community. We sequenced 166 mumps virus genomes collected during outbreaks in Washington and other US states, and apply phylodynamic approaches to trace mumps introductions and transmission within Washington. We uncover that mumps was introduced into Washington at least 13 times, primarily from Arkansas, sparking multiple co-circulating transmission chains. Neither vaccination status nor age were strong determinants of transmission. Instead, the outbreak in Washington was overwhelmingly sustained by transmission within the Marshallese community. Our findings underscore the utility of genomic data to clarify epidemiologic factors driving transmission, and pinpoint contact networks as critical determinants of mumps transmission. These results imply that contact structures and historic disparities may leave populations at increased risk for respiratory virus disease even when a vaccine is effective and widely used.